You Can't Love Them All

By Felice Dunas, PhD

We have all had them - the patients we have personal difficulty working with. The ones that inspire us to inadvertently wince when we see their names on the schedule, or spontaneously pause and inhale before entering treatment rooms.

With some we even sigh with relief as they leave. They may be complainers, perhaps they smell bad, and sometimes they are too effusively filled with gratitude. Maybe they just rub us the wrong way or aren't the sort of people we would have in our lives if they weren't laying on treatment tables in our offices. We can't naturally like everybody, though we do our best with them all.

Back in the 70s' and 80s' I had no lightweight cases. Few people would consider an acupuncturist, unless they were half dead, had already lived though 10 failed surgeries or were about to commit suicide from their health problem. My work was simply, the last possible choice and the last possible chance. The difficulty that I had with these people was the amount of time it took to get them feeling well enough to evoke so much as a smile. Every day felt heavy and every patient was depressed. It was tough facing so many uphill battles and I worked hard to create healing and laughter. Of course, once we turned their health around people would get happy, which made things easier for me as well. But, until that point it was rough going. You may have noticed this scenario in your practice as well.

Whatever personal qualities you find difficult in your patients, it's important to be honest about them. Pretending, or shoving down your feelings can deprive you of the benefits brought on by treating and interacting with them. The difficulty that I had with the abundance of very sick people during the early decades of my practice was the motivation for my writing a book and beginning an international lecture career because I needed a lighter experience in my work. From the yin, I created yang. Here are some other ways to use the darkness of your personal difficulty with patients to create more light in your practice and personality.

Keep Some Distance

Difficult patients remind you of the importance of setting boundaries and maintaining emotional distance. No matter how much you enjoy a patient's personality, it is not your job to become a friend. You must maintain professionalism such that you can say and suggest anything necessary for the patient, whether or not she likes it. It is all too easy for practitioners to lose ground, to slip in their standing with a patient, unintentionally giving power away. This is often the case for practitioners working with celebrity patients or with a very small number of people upon whom their entire income rests. If an acupuncturist feels dependent in any way that would allow them to fudge on their boundaries, their standing is lowered in the practitioner/patient relationship. When we are forced to set clear boundaries, we are reminded of their importance. If the occasional difficult patient reminds you of the value that strong boundaries bring to your practice, you are better off. Professionalism makes the relationship work, not camaraderie.

Difficult patients require you to work at cultivating empathy and compassion. It's easy to feel compassion for someone you naturally like. But, what about someone you don't like? What if he irritates you to no end? What if he is arrogant or bigoted or hateful or bullying? How easy is it to feel compassion then? If you wish to use your practice as a spiritual path, in a sense, as an opportunity to cultivate wisdom, difficult patients are a blessing. They remind you to grow, as a person and reflect goodness in your behavior no matter how others act. They help you make yourself kinder and more respectful.

Elevate The Spirit

The Shang Han Lun tells you that it is your job, above all, to elevate the spirit of your patient. Sometimes the body cannot be healed so one must continually strive for that which can always be improved upon, even as a patient faces death. When interacting with a patient you don't enjoy personally you are reminded of this obligation. When you feel slightly uncomfortable you are reminded of the importance of rising above transient emotions and focusing on a higher goal.

These patients motivate you to cultivate patience. The more someone behaves in a manner you don't like, the more patience you are required to use to create a positive experience with them. Patience is one of the great virtues of our medicine. One of the greatest tools for cultivating wisdom, the wisdom that makes you a master of your craft, is patience.

These patients humble you. It is easy to think a bit too well of one's self when your practice is flowing smoothly, but I assure you that 41-plus years into this gig, I still don't know very much. When a personally difficult patient comes along I am reminded of how little I know and how essential it is to approach each individual and each case with humility. The medical aspect of the case is not the only component that must be worked with. The interactive aspect, the doctor/patient relationship, is also intrinsic to the healing process.

Be Positive

You must reflect an uplifting attitude for those you treat. Your demeanor must be pleasant, professional and positive. When having to give bad news this can be especially important and challenging. Due to the level of artistry required, this skill must be continually practiced and personally difficult patients give you the opportunity to stay well rehearsed. When your natural inclination is to interact less with someone, having to be direct and involved means that your professional demeanor remains in use and polished.

It is your duty to let go of judgment and criticism and to see all people for the energetic power that is their essence and birthright. You must be able to experience people as qi, in its many forms, to know what must be done to move them forward towards health. Having this ability allows you to identify ideal health for them and to help them strive towards it. When working with a difficult patient you are reminded that your practice is about the people but not, in some respects, in a personal way. Your goal is to effect qi, which ultimately changes all aspects of who someone is and their experience of life.

The Lesson

Difficult patients motivate you to hold yourself to a higher standard of thought and to let go of judgments. Without them, you could misjudge yourself, thinking that your critical voice is quieter than it is. It takes a challenge to help you to see the darker side of your own personality. If you don't know it's there or if you believe you have left your bigotry and criticism behind, you will not clean yourself of it.

Your OM practice provides a tremendous growth opportunity for you as a person. Sometimes growth is most apparent in the face of challenge. If you take advantage of the wisdom generating opportunities provided by personally difficult patients you can open heartedly welcome all who come to your practice. You change the energetic dynamics that are your motivation as a practitioner and you move into greater alignment with the Tao. Isn't that, ultimately, where you want to be?

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